Amir Matityahu, M.D. Shows How Broken Bones Are Repaired Using High-Tech Imaging

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The San Francisco orthopaedic surgeon says that minimally-invasive procedures can often help a patient heal faster.

Amir Matityahu, M.D., Director of Pelvic and Acetabular Trauma and Reconstruction at San Francisco General Hospital says that new-generation imaging technology is assisting orthopaedic surgeons in planning the best course of treatment for repairing broken bones.

Dr. Matityahu says that one of his patients recently benefited from these new surgical approaches and imaging technology. The patient, Jenna Quarnes is a 24 year-old labor & delivery nurse who crashed her bike after her wheel caught in a MUNI rail line, sustaining multiple pelvic injuries.

"She had a bicycle accident on 4/19/11 that sustained a right both column acetabulum fracture and right sacroiliac joint dislocation," says Dr. Matityahu. "X-rays of the pelvis and a CT scan were performed. We are lucky that we have the technology to apply to the pelvis with 3D reconstructions and 3D planning of our future internal fixation. So, this is what we did. After discussing with her and her mom regarding the surgery so that they understood exactly what we were going to do, we pre-operatively planned the surgery on the virtual work planning software."

"Jenna sustained her injuries just three days after starting her new job at San Francisco General Hospital last April," says Dr. Matityahu. Since having her surgery, she has fully recovered from her injuries and has resumed working at her job in labor & delivery. Jenna says she will be able to get married later in October, as she had planned.

Dr. Matityahu says that Jenna's procedure took less time to complete than was previously required for such a complex injury because it was performed with minimally invasive techniques, thanks in part to new generation imaging technology. "These factors can make the procedure less traumatic for the patient and allow faster healing times in many cases," he says.

"We have been working on advancing the software for the development of the computer assisted navigation of pelvis fractures," says Dr. Matityahu. "In this case, we were able to use this equipment to first create a virtual space that is represented on the computer screen. We are then able to move instruments and implants within that virtual space to allow very precise insertion of implants into corridors of bone that are barely able to accommodate these implants. Moreover, this can be done in 2D or 3D imaging."

"2D is taking several images using the fluoroscopic equipment and storing them in the computer," say Dr. Matityahu. After the computer recognizes the equipment, I am able to move the equipment virtually within the captured images and actually relative to the patient without having to re-take the images again and again every few seconds to see where the equipment is located relative to the images."

"3D imaging creates an intra-operative CT scan and stores it in the computer'" says Dr. Matityahu. "The navigation equipment registers the images, implants, and tools that we will use to place the hardware. After the computer recognizes the equipment, I am able to move the equipment virtually within several different cross-sectional CT images and also relative to the patient without having to re-take the images again. This technique actually lets me see where the trajectory of my implants is with in the bone allowing intra-operatively planning as I go,” says Dr. Matityahu.

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Gary Grasso
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